Kidney diseases Flashcards
What is glomerulonephritis?
Non-infective inflammation of the glomeruli of the kidney, often with an immunological cause
What is pyelonephritis?
Bacterial infection of renal pelvis, calyces, tubules and interstitium
What is the most common causative organism of pyelonephritis?
E. coli
Which gender is pyelonephritis more common in?
Female
How does pyelonephritis occur?
Infection from haematogenous spread
Ascending infection
What are the risk factors for pyelonephritis?
Urinary tract obstruction
Vesico-ureteric reflux
Diabetes
What would indicate chronic pyelonephritis
Symptoms often vague
Hypertension/uraemia
Large volume of urine
What would be seen on imaging of the kidney in chronic pyelonephritis?
Coarse cortical scarring
Distortion of calyces
What is chronic pyelonephritis associated with?
Chronic kidney disease
Hypertension
What are the symptoms of tubercular pyelonephritis?
Weight loss
Fever
Loin pain
Dysuria
How does tuberculosis normally reach the kidney?
Haematogenous spread from lung
What is sterile pyruria and what disease does it occur in?
Tubercular pyelonephritis
Pus in urine, but doesn’t grow organisms on culture because TB takes weeks to grow in special medium
What pathology might be seen in tubercular pyelonephritis?
Caseous foci – slow growth with progressive renal destruction
Spread to ureters, bladder and other viscera
Typical caseating granulomatous inflammation
Mycobacteria may be seen on histological special stains (Zeehl-Neilsen) but absence does not exclude TB
What bacteria cause cystitis?
E. Coli.
Klebsiella
Proteus
Pseudomonas
What is cystitis?
Inflammation of the bladder caused by a urine infection
Why is cystitis associated with outflow obstruction particulary dangerous?
Can become necrotising if associated with outlet obstruction
What is ureteritis/cystitis cystica?
Multiple small fluid filled cysts projecting into lumen as a result of chronic inflammation/irritation
Can resemble tumours
What organism can predispose to malignancy, particularly squamous cell carcinoma of the bladder?
S. Haematobium - schistosomiasis
What can be a result of prolonged bladder outlet obstruction?
Hypertrophy of the detrusor muscle, which can cause diverticular formation
Which problem in neonates can cause urethral outflow obstruction?
Posterior urethral valves
What is hydronephrosis?
Dilatation of pelvicalyceal system with parenchymal atrophy
What are the main causes of hydronephrosis?
Urinary tract obstruction
Reflux
What is this?
Hydronephrosis
What is the most common cause of urinary outflow obstruction in the elderly male?
Prostatic enlargement or tumour
What is the inheritance pattern of adult polycystic kidney disease?
Autosomal dominant
Abnormality on chromosome 16
How does adult polycystic kidney disease usually present?
Middle age
Abdominal mass
Haematuria
Hypertension
Chronic renal failure
Fatigue
What are the pathological characteristics of adult polycystic kidney disease?
Massive bilateral renal enlargement
Multiple cysts of varying size
Distortion of reniform shape
Cysts arise in any part of nephron
What other extrarenal complications is adult polycystic kidney disease associated with?
Cysts in liver, pancreas, lung
Association with berry aneurysm in the circle of Willis
What is the significance of increased risk of berry anuerysms associated with polycystic kidneys?
Increased risk of subarachnoid haemorrhage
Where are fibroma found in the kidney and what is their appearance?
Medulla
White nodules
Where are adenoma found in the kidney and what is their appearance?
Cortex
Yellowish nodules <2cm
What is angiomyolipoma and where might they be in the kidney?
Mixture of fat, muscle and blood vessels
Can be multiple and bilateral
What disease is angiomyolipoma associated with?
Tuberous sclerosis
How might a juxtaglomerular cell tumour present?
Secondary hypertension due to increased renin
What is the most common intra-abdominal tumour in children and from which tissue does it arise?
Nephroblastoma (Wilms’ Tumour)
Arises from residual primitive renal tissue
What is the commonest primary renal tumour in adults?
Renal cell carcinoma
What age and gender does renal cell carcinoma usually present in?
Age 55-60
M:F 2:1
How does renal cell carcinoma present?
Abdominal mass
Haematuria
Flank pain
General features of malignant disease
What are the paraneoplastic manifestations of renal cell carcinoma?
Polycythaemia (overproduction of red blood cells)
Hypercalcaemia
Where do renal cell carcinomas arise and what is their appearance?
Large, well circumscribed mass on the cortex
Yellow colour, with solid, cystic, necrotic and haemorrhagic areas
Where do renal cell carcinomas commonly extend into?
Renal vein
Can continue into vena cava and right atrium
How does renal cell carcinoma usually spread and to where?
Through blood
To lung and bone
What is the most common cell type in renal cell carcinoma and what are these cells?
Clear cell
Tumour cells rich in glycogen and lipid
Which type of carcinoma affects the renal pelvis?
Transitional cell carcinoma
What imaging is used to diagnose renal cell carcinoma?
Ultrasound
Triple phase contrast CT
What system is used to stage renal cell carcinoma?
Robson staging
What surgical treatments are there for renal cell carcinoma?
Radical nephrectomy
Partial nephrectomy
Radiofrequency ablation
What is the definition of chronic kidney disease?
Chronically reduced GFR and evidence of kidney damage
How can GFR be estimated?
Creatinine clearance
Why is creatinine clearance only an estimate of GFR?
Secreted from tubules
Increased in muscular people
Needs to be stable - fluctuates during illness in hospital
Requires 24 hour urine collection which is often done inaccurately
What is the definition of stage 1 chronic kidney disease?
GFR > 90ml/min with evidence of kidney damage
What is the definition of stage 2 chronic kidney disease?
GFR 60-90ml/min with evidence of kidney damage
What is the definition of stage 3 chronic kidney disease?
GFR 30-60ml/min
(1 in 20 people will have a GFR like this normally)
What is the definition of stage 4 chronic kidney disease?
GFR 16-30ml/min
What is the definition of stage 5 chronic kidney disease?
GFR <15ml/min or renal replacement therapy
Which factors indicate that someone is more likely to progress to a higher stage of chronic kidney disease?
Proteinuria
Younger age at onset
What is the most common cause for requirement of dialysis?
Diabetic nephropathy
What are the common causes of CKD?
Diabetes
Hypertension
Vascular disease
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidneys
When do symptoms usually present in chronic kidney disease?
Late: GFR usually <20ml/min
What are the symptoms of chronic kidney disease?
Tiredness
Poor appetite
Itch
Sleep disturbance
Impaired urinary concentrating ability – symptoms may occur earlier - nocturia
How is progression of CKD slowed?
Reducing proteinuria and managing blood pressure:
ACEi/ARBs do both
Spironolactone
Stopping smoking
Managing diabetes
What side effects must you be aware of when starting a patient on ACEi or spironolactone for CKD?
Initial fall in GFR
Hyperkalaemia
Why does anaemia occur as a side effect of CKD?
Erythropoietin produced by the kidneys and production declines in CKD
Why is bone disease a complication of CKD?
Vitamin D hydroxylated in the kidney - impaired in CKD
Leads to reduced calcium absorption, leading to secondary hyperparathyroidism
In advanced CKD, serum phosphate rises – also increases PTH secretion
What can result from high phosphate and high calcium?
Calcified vessels and heart valves
How is bone disease treated in relation to CKD?
Alfacalcidol
Advice on phosphate intake
Phosphate binders
What is reflux nephropathy?
Angles of the ureters fail to shut the valves properly, causing reflux
Kidneys become small and scarred due to vesico-ureteric reflux
Sometimes called chronic pyelonephritis
Which patients is reflux nephropathy most common in?
Children
When do hepatic cysts associated with polycystic kidneys tend to arise?
10 years after kidney disease
What cardiac disease is associated with polycystic kidney disease?
Mitral/aortic valve prolapse
Valvular disease
What GI disease is polycystic kidney disease associated with?
Diverticular disease
Diverticulitis and perforation are 2 important complications
How should polycystic kidney disease be managed?
Rigourous control of hypertension
Hydration
Proteinuria reduction
Where are cysts seen coming from in autosomal recessive polycystic kidney disease?
Seen appearing from the collecting system
Which pattern of inheritance is Alports syndrome?
X-linked recessive
What is Alports syndrome?
An inherited nephritis caused by a defect in type IV collagen matrix
What are the renal manifestations of Alports syndrome?
Haematuria initially
Proteinuria later
What renal manifestation is a bad prognostic sign in Alports disease?
Proteinuria
What are the extra-renal manifestations of Alports syndrome?
Sensorineural deafness
Ocular defects-anterior lenticonus
Leiomyomatosis of oesophagus/genitalia-rare
What is the characteristic feature on biopsy of Alports syndrome?
Variable glomerular basement membrane thickness
What is Anderson-Fabrys disease?
An X linked disease lysosomal storage disease affecting kidneys, liver, lungs and erythrocytes
